Monday, April 12, 2010

The Illogical Nature of Euthanasia

For the Christian in medicine probably the biggest challenge on the horizon is that of euthanasia. The Joffe Bill was rejected by the House of Lords in Britain, but it will only be a matter of time before it re-emerges in one form or another. The issue for the Christian therefore is to be prepared not if the debate re-arises but when. How though do we develop our arguments in the face of overwhelming secular support? After all euthanasia is murder: it is the willful removal of one person's life by another. However, the argument for euthanasia is far more nuanced than just that and so the Christians response should be as well. Indeed to remain mired in this binary way of thinking belies our beliefs and I think if left unchecked misrepresents the character of God. It is wrong because it is more than just murder - euthanasia goes to the core of what it is to be human and how we value humanity.

The strongest argument for the institution of euthanasia into law rests upon the concept of autonomy - essentially the freedom to choose: we should be allowed to choose what we want for ourselves at all parts of our lives including when and how we die. Now this is a compelling argument (despite the fact that autonomy is the weakest of the four medical ethical principals), but there exists within euthanasia difficult and irreconcilable contradictions which arise from this foundational principle and the following four statements which must be true for euthanasia to be admissible under current thinking:

There should be terminal illness with a short life expectancy.

There should be 'unbearable suffering'.

There should be a persistent request to die.

The patient should legally competent to take such a decision.

Advocates would say that these four principles must be present before euthanasia can legally proceed. Yet this patently can never be the case. If we are to hold to the over-riding belief that autonomy is king over all moral and medical principles then it would be unethical to restrict euthanasia to just those who have a short life-expectancy and suffering - no, we should, morally, extend euthanasia to those who are suffering but do not have a short life-expectancy (say if we were confined to a wheelchair). Or what about if I have a terminal illness and a desire to die but yet am not suffering (say for instance early motor neuron disease)? Logically you must deny me that right, yet you would not be moral or ethical to do so according to our precepts above.

This descends further if one considers sufferingper se to be a moral justification for killing someone. If someone is suffering so we then not have an obligation to euthanise them whether they have a terminal diagnosis or not? You wouldn't let a dog suffer, so why a human? Should we not act to end their suffering whether they wish to die or not. What constitutes suffering? Pain? Restriction of movement? Sadness? Who are you to determine whether I am suffering or not? We deny autonomy because we feel that we cannot satisfy our other requirements.

The problems here should start to become clear - this is the beginning of the much maligned slippery slope. We have innumerable historical instances of the ways in which man misappropriates good intentions - despite what the official stance may be in Britain it is possible to gain abortion on demand. The original abortion legislation was designed to protect women from backstreet abortion clinics and the deaths they inevitably brought, but that has been liberalised with overwhelming social pressure into something completely different.

Why though should be anything otherwise? The Bible clearly teaches that we cannot handle the responsibility of the knowledge of life and death (Genesis 2:8-17). Eating of the Tree of Life endowed us with great power - the power of morality. We gained knowledge of all the good and bad that may be done on this earth, yet are completely incapable to utilise that power in a holy, meaningful way - we succumbed to sin and death. Only God is able to have full knowledge of good and evil and act in a perfectly moral way. How we long to be able have all of this knowledge, yet we are totally incapable of its application. We distort and bend our precepts to fit a desired conclusion but end up contradicting ourselves. Despite these inconsistencies the appeal is still made to autonomy for euthanasia yet it is a self-defeating process. There cannot be a series of requirements that reconcile our need for autonomy with our attempts towards morality. We attempt to establish black-and-white lines for ourselves and just smear them whilst we're waiting for the paint to dry.

My concern in these posts is manipulation: that the writer manipulates the data to suit the conclusion. I hope that would not seem the case. If so I apologise. I just cannot see how the above points can be reconciled and yet very few make mention of this seeming self-defeater (to use philosophical parlance). We need not hide behind simplistic arguments to oppose euthanasia - man after all has a handy habit of defeating himself.

Born in England and raised as an expatriate I came to faith at age 20. Studied at the University of Edinburgh and currently work in Edinburgh as a doctor. I am involved in the student ministry at Charlotte Chapel in Edinburgh.

3 comments:

I'm always glad to see posts that should spark discussion, and this certainly fits that bill. You've done a nice job outlining some of the things to be considered on this topic, but I do want to ask about this statement:

"...there exists within euthanasia difficult and irreconcilable contradictions which arise from this foundational principle and the following four statements which must be true for euthanasia to be admissible under current thinking:

1.There should be terminal illness with a short life expectancy.2.There should be 'unbearable suffering'.3.There should be a persistent request to die. 4.The patient should legally competent to take such a decision.Advocates would say that these four principles must be present before euthanasia can legally proceed. Yet this patently can never be the case. If we are to hold to the over-riding belief that autonomy is king..."

My problem here is that I do not understand why you say those four principals "can never be the case" and then follow that up by saying "if we are to hold...". I mean it seems that you prove yourself wrong immediately. The four principals CAN most certainly be applied, and easily too, by simply NOT holding to the belief that "autonomy is king." Yes, I've no doubt that you can find this contradiction out there--an argument which says 1) people should have the freedom to make their own decisions on this matter and 2) people should only be allowed to make this decision when these four things apply. And if you find any such people arguing both of those positions, you can point out their contradictions. But there's no reason to presuppose that everyone who holds to the four principals is also going to argue that "autonomy is king," especially in a legal sense (since we are talking about laws.)

One can certainly say something like "I believe people should have the right to decide their own fate, including the end of their own life" while also saying "but I understand the medical and legal/societal need to have restraints and restrictions on when (as well as how, which also might run counter to "choice") euthenasia is performed."

So how does the extension of life for a month, or a year or two, by the use of a long list of drugs, organ transplants, and respirators fit into this reasoning. If I were to get cancer I am not going to lay in a hospital rotting from the inside out with megadoses of drugs to keep breathing for another day. That, I think is torture. I have seen it happen several times. I believe God lets one know when its time, and society shouldn't interfere.

Johnnie - you are, of course, right. These points are taught to medics and students at medical school and are seen as water-tight arguments for the legalisation of euthanasia. Of course the argument can be seen on both sides (Jesus after all was an empathetic guy as well). I don't think I carried that across very well. I just get very bored of this stuff being wheeled out the whole time, when there are problems with it.

Scrapiron - I again totally agree. There is a tension for the medic with balancing God's will with prolonging life. I guess it's a question of discernment, but He has revealed these developments to us and we to use them responsibly.

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